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In some patients with UNIPOLAR pacemakers, repolarization tail may result in double heart rate counting. Do not use pacemaker spike's size and/or shape for diagnosis. Pacemaker spike's size and/or shape may vary from patient to patient. Heart rate double counting may be seen in some pacemaker patients due to separate counting of the pacemaker spike and the following QRS complex. In such patients, do not rely only on the rate meter alarms. If a pacemaker patient developes arrhythmias, the rate meter of the monitor may reflect the pacemaker rate. Such patients must be kept under close observation. This may result in failure to detect asystole.
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If a pacemaker patient developes asystole, the monitor may count pacemaker spikes as QRS complexes. the lead with the largest pacemaker spike must be chosen. PACE PROGRAM must be activated in some commercially available monitors.
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Monitoring patients with cardiac pacemakers A similar observation may be seen in patients with atrial flutter Since monitors derive instantaneous heart rate from RR interval, it is normal for a monitor to depict abruptly changing heart rates in accordance with the abruptly changing RR intervals. This is normal for an irregularly irregular rhythm in which RR intervals change abruptly. When monitoring patients with atrial fibrillation, abrupt changes may be observed in heart rate. Increasing the size of ECG waves on the monitor display does not increase diagnostic capability. Unlike true ischemia, this type of positional ST segment fluctuations are usually accompanied by QRS changes. ST segment may show fluctuations due to changes of the body position. However this necessitates good ECG signal acquisition to prevent artifacts. Some monitors can follow ST segment changes to detect silent ischemia.
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the electrodes should be placed so that the current from the surgical burning area to the return electrode does not go through the measured ECG lead.Ĭommenting on the ECG data being displayed on the monitor To minimize interference from electrosurgery unit, electrocautery, etc. Therefore choose leads with small P waves. This may result in failure to detect the asystole. If asystole developes during monitorization of a patient with tall P waves, the monitor may erroneously count P waves as QRS complexes. To prevent double heart rate counting, leads with tall and narrow QRS complexes but with small P and T waves must be preferred for monitoring. Leads showing biphasic QRS complexes are not preferred. Leads with monophasic QRS complexes (either completely positive or completely negative) should be chosen. Alternatively 5- or 10-electrodes may be used for monitoring. However, it does not permit ST segment monitorization or differentiation of ventricular tachycardia from supraventricular tachycardia. This type of electrode placement is the oldest and simplest type of cardiac monitoring, and permits only the monitorization of leads I, II and III. The left leg ( LL ) electrode is placed below the rib cage on the left side of the abdomen. The left arm ( LA ) electrode is placed on the infraclavicular fossa close to the left shoulder. The right arm ( RA ) electrode is placed on the infraclavicular fossa close to the right shoulder. This reduces muscle artifact due to limb movement and avoids tethering the patient. Unlike standard 12-lead ECG, the bedside cardiac monitoring limb electrodes are placed on the torso. When placing electrodes on the body, choose non-muscular and flat sites to avoid interference by the muscular movement. If you will use snap leadwires, then it will be better if you attach the leadwires to the electrodes first, then apply the electrodes to the patient. If hair is present on the skin, shave it before applying the electrodes on the surface.
#Heart monitor lead placement skin
Ether or pure alcohol will dry the skin and increase its resistance. Skin oils and cutaneous debris must be removed. Before monitorization, you must prepare the skin for good skin-electrode contact. The skin is a poor conductor of electricity. On the other hand, prolonged monitorization of cardiac rhythm and possible ST segment deviation are not the primary objectives of ECG machines.Īrrhythmia detecting algorithms may vary among commercially available monitors. Monitors are used to display (and sometimes record) heart's rhythm and the ST segment deviation for a long time.